General Principles in Treating Liver Disease Flashcards
How does SAMe help with liver disease?
It is involved in glutathione production, and glutathione is an anti-oxidant that’s made in the liver
- so it minimize the depletion of glutathione stroage
- it may also have direct anti-inflammatory properties, modulates apoptosis, and be anticarcinogenic
How does N-acetylcysteine (NAC) help with liver disease?
Similar to SAMe, helps with glutathione production
- oral leads to vomiting, so IV use only
- prolonged usage may interfere with ammonia metabolism
- may be used in acute liver injury/ toxin/drug; hepatic lipidosis
How does silymarin help with liver disease?
It’s an anti-oxidant, as well as an anti-inflammatory
- free radical scavenger, reduces lipid peroxidation
How does vitamin E help with liver disease?
- free radical scavenger
- no study proves efficacy in hepatic disease, but has shown clinical benefits in dogs with atopic dermatitis or degenerative joint disease
How does ursodeoxycholic acid (UDCA) help with liver disease?
It has cholerectic effect –> increases excretion of endogenous toxins in the bile
- also cytoprotective (inhibits hepatocyte apoptosis)
- and immunomodulatory (ex. suppression of IL-2 expression)
Mainly used for cholestasis, maybe useful for chronic hepatitis
What are some immunosuppressive drugs that can be used for idiopathic chronic hepatitis?
- glucocorticoids (pred): may be beneficial
- azathioprine (NOT in cats): no sure
- cyclosporine: need more study
How does D-penicillamine help with liver disease?
Used in chronic hepatitis due to copper-storage disease
- it’s a chelator –> bind to copper (and other heavy metals) –> mobilized from the liver –> excretion in the urine
- also anti-fibrotic and immunomodulatory
- affected dogs will need life-long treatment and copper restricted diet
- watch for microcytic, hypochromic anemia
- can also cause GI signs (take with food) but best absorption is on empty stomach
How does trentine help with liver disease?
Another chelator, 2nd choice to D-penicillamine
- use if dog not tolerating D-penicillamine, but vomiting/ anorexia can still happen
- can remove more copper from circulating pool than tissue, so may be a good choice for dogs with hemolysis due to high serum copper
- still need more research
How does zinc help with liver disease?
It decreases GI absorption of copper
- Zinc induces metallothionein production –> binds to copper
- when enterocytes dies/ sloughs off, the copper inside them goes as well
- typically used after a chelator has reduced the serum copper level (in most liver disease diet)
- if serum zinc becomes excessive high, can induce hemolysis
- vomiting and nausea = AE, but typically well tolerated
How is acute liver injury/ acute liver failure treated?
Aggressive supportive therapy
- emesis if toxin ingestion
- address oxidative injury –> SAMe, N-acetylcysteine, vitamin E
- aggressive fluid therapy
- watch for multi-organ dysfunction (ex. kidney injury)
- GI protectant, anti-emesis
- treatment for increased intracranial pressure due to cerebral edema (associated with hepatic encephalopathy)
- elevate head
- vitamin K supplementation
- watch if giving store whole blood –> has high ammonia levels
- actively screen for infection
- coagulopathy usually not clinical
How is chronic liver hepatitis treated?
Important to find underlying cause
- can still use hepatoprotectants like SAMe and silybin
- liver biopsy is needed to determine the etiology
- if copper storage - chelation - repeat biopsy in 6m to determine if continue on to switch to zinc
- should also submit for anerobic/ aerobic culture esp if granulomas are noted
- fungal/ bacterial causes – bartonella, canine schistosomiasis, mycobacterium
- if inflammatory – immunosuppression/ prednisolone
- there is an increased risk of gastroduodenal ulceration with portal hypertension
How is hepatic fibrosis treated?
There is no proven treatment
- removing source of inflammation, which may lead to fibrosis
- use antioxidants
How is hepatic encephalopathy treated?
- use non-meat based protein
- lactulose (decreases GI absorption of ammonia)
- metronidazole?
How should ascites be treated?
Spironolactone
